Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | DAPT000658 | PA |
Y | 225100000X | Physical Therapist | PT013857L | PA |
N | 2251S0007X | Physical Therapist - Sports | DAPT000658 | PA |
N | 2251S0007X | Physical Therapist - Sports | PT013857L | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | DAPT000658 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT013857L | PA |
NPI | 1184694564 |
---|---|
Provider Name | Mr. Lawrence M Grello |
First Address | King Of Prussia, PA 19406-4201 |
Second Address | King Of Prussia, PA 19406-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 13/08/2013 |